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(d) The conditions under which this method is indicated, or contra-indicated,
can scarcely be definitely laid down as yet, because of the many practical
limitations to which my activities have been subjected. Nevertheless, I will attempt
to discuss a few of them here:
(1) One should look beyond the patient’s illness and form an estimate of his
whole personality; those patients who do not possess a reasonable degree of
education and a fairly reliable character should be refused. It must not be
forgotten that there are healthy people as well as unhealthy ones who are good for
nothing in life, and that there is a temptation to ascribe to their illness
everything that incapacitates them, if they show any sign of neurosis. In my
opinion a neurosis is by no means a stamp of degeneracy, though it may often enough
be found in one person along with the signs of degeneracy. Now analytic
psychotherapy is not a process suited to the treatment of neuropathic degeneracy; on
the contrary, degeneracy is a barrier to its effectiveness. Nor is the method
applicable to people who are not driven to seek treatment by their own sufferings,
but who submit to it only because they are forced to by the authority of
relatives. The qualification which is the determining factor of fitness for
psycho-analytic treatment - that is, whether the patient is educable - must be
discussed further from another standpoint.
(2) To be quite safe, one should limit one’s choice of patients to those who
possess a normal mental condition, since in the psycho-analytic method this is
used as a foothold from which to obtain control of the morbid manifestations.
Psychoses, states of confusion and deeply-rooted (I might say toxic) depression
are therefore not suitable for psycho-analysis; at least not for the method as
it has been practised up to the present. I do not regard it as by any means
impossible that by suitable changes in the method we may succeed in overcoming
this contraindication - and so be able to initiate a psychotherapy of the
psychoses.
(3) The age of patients has this much importance in determining their
fitness for psycho-analytic treatment, that, on the one hand, near or above the age
of fifty the elasticity of the mental processes, on which the treatment depends,
is as a rule lacking - old people are no longer educable - and, on the other
hand, the mass of material to be dealt with would prolong the duration of the
treatment indefinitely. In the other direction the age limit can be determined
only individually; youthful persons under the age of adolescence are often
exceedingly amenable to influence.
(4) Psycho-analysis should not be attempted when the speedy removal of
dangerous symptoms is required, as, for example, in a case of hysterical anorexia.